On April 23, 2018, CMS issued a request for information on direct provider contracting models. In that request, (attached hereto as a PDF), CMS stated as follows: “Under a primary care-focused DPC model, CMS could enter into arrangements with primary care practices under which CMS would pay these participating practices a fixed per beneficiary per … Continue Reading
Although it has been almost a decade since the OIG has issued a gainsharing opinion, OIG Advisory Opinion No. 17-09 confirms the federal government’s support of the pay for performance concept. OIG 17-09 is the first gainsharing opinion issued since the 2015 amendment of the Civil Money Penalty statute (42 U.S.C. § 1328-7a(b)(1)). As you … Continue Reading
In Robie v. Price, Dr. Robie successfully obtained a temporary restraining order prohibiting CMS from terminating his Medicare billing privileges prior to the exhaustion of his administrative remedies by the U.S. District Court for the Sothern District of West Virginia. As most realize, exhaustion of administrative remedies is usually a prerequisite to further litigation for … Continue Reading
The Texas Medical Board and Teladoc have been battling for seven years, and through several rounds of litigation over whether a patient relationship can be established for purposes of providing telemedicine services without an initial face-to-face or in-person visit. This all changed when Texas governor, Greg Abbott, signed Senate Bill 1107, which will take effect … Continue Reading
Emanuele v. Medicor Associates, was presented to the United States District Court for the Western District of Pennsylvania as cross motions for summary judgment, and provides some guidance regarding the Stark requirements for bona fide personal service contracting arrangements. The case originated as a whistleblower allegation that Hamot Hospital had not complied with all of … Continue Reading
On January 12, 2017, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) issued final rules implementing permissive exclusion authorities authorized by the Affordable Care Act expanding exclusion authority under Section 1128 of the Social Security Act. The changes were first proposed on May 9, 2014 at 79 Federal … Continue Reading
Use this link to view the article “Pennsylvania’s New Opioid Laws and How They Impact Physicians” that appeared in a recent edition of the Allegheny County Medical Society Bulletin. For additional information contact Lauren Rulli (lrulli@tuckerlaw.com) or Mike Cassidy (mcassidy@tuckerlaw.com).… Continue Reading
It has not been unusual for employed physicians to seek the protection provided to independent medical staff members through the due process procedures provided by medical staff by-laws. The case of Levitin and Chicago Surgical Clinic v. Northeast Community Hospital is the exact opposite; Dr. Levitin was an independent medical staff member seeking Title VII … Continue Reading
PBGH just recently sent out a client alert regarding UPMC/Highmark Continuity of Care Settlement as follows: UPMC and Highmark have announced a settlement agreement that addresses the Consent Decrees’ Continuity of Care provision. This settlement will govern continuity of care beginning January 1, 2016 until the end of the Consent Decrees on June 30, 2019. … Continue Reading
The ruling by Judge Ward of the Allegheny County Court of Common Pleas highlights another facet of the ongoing dispute between UPMC and Highmark. On February 18, 2015, Judge Ward of the Allegheny County Court of Common Pleas ruled that the arbitration agreements contained in the various agreements between Highmark and UPMC hospitals, most of … Continue Reading
On January 15, 2015, the Pennsylvania Superior Court in Bair v. Manor Care of Elizabethtown, PA, LLC 2015 Pa. Super. 9 (2015) ruled that a nursing home arbitration agreement was not enforceable when the facility did not sign the agreement. M. Sylvia Bair commenced this action for wrongful death and survival in the Court of … Continue Reading
Scott Leah, an attorney in Tucker Arensberg’s Pittsburgh office, recently circulated the below client alert: Employers with more than 50 employees need to be aware of a recent ruling on FMLA notices, which employers are required to give to employees. In Lupyan v. Corinthian Colleges, Inc., 761 F.3d 314 (3d. Cir. 2014), the employer mailed an … Continue Reading
Michael Cassidy was recently appointed as counsel for the Allegheny County Medical Society (ACMS). More information can be found at the below link. http://www.tuckerlaw.com/2014/09/29/michael-cassidy-appointed-counsel-allegheny-county-medical-society/… Continue Reading
Mike Cassidy was published in the July 2014 edition of the Allegheny County Medical Society Legal Bulletin regarding Highmark and UPMC Consent Decree. You can read the article, here.… Continue Reading
http://www.attorneygeneral.gov/press.aspx?id=7909 Included is the link to the PA Attorney General announcement on the UPMC – Highmark Consent Decree. I will be adding mu=y summary and comments later today. Mike Cassidy… Continue Reading
In a recent decision that has been making headlines across the country, a Pennsylvania federal court held that a local Cambria County company conducted over 300 unlawful pre-offer medical exams in violation of the ADA. Cambria Care Center (“CCC”) had purchased the former Cambria County owned nursing home and engaged Grane Healthcare (a separate, but … Continue Reading
Practical considerations to protect against being ‘out of network’ The disengagement of Highmark and UPMC is looming on the horizon; most of the hospital participation agreements between these two competing healthcare systems end on December 31, 2014. There are some hospital agreements that continue, such as those at Children’s and Magee, but the focus of … Continue Reading
Microsoft recently announced that, after April 8, 2014, it will not longer provide security updates or technical support for Windows XP. Microsoft’s statement that “businesses that are governed by regulatory obligations such as HIPAA may find that they are no longer able to satisfy compliance requirements” has spurred a certain level of panic among health … Continue Reading
New joint legislation to repeal Medicare’s failed SGR formula is advancing to both chambers of Congress following an agreement announced Thursday by the three committees that put forth repeal bills earlier this session. “The AMA congratulates House and Senate negotiators for taking this critical step toward reforming the nation’s Medicare program,” AMA President Ardis Dee … Continue Reading
Accretive Health recently agreed to settle a Federal Trade Commission (FTC) complaint that stems from a July, 2011 incident in which an Accretive employee’s laptop was stolen from his car. As a medical billing and revenue management services provider, Accretive grants its employees access to “sensitive personal health information” including “patient names, dates of birth, … Continue Reading
The Department of Health and Human Services (HHS) has released a proposed rule that would modify the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule by allowing health care providers to make certain disclosures to the National Instant Criminal Background Check System (NICS). The NICS aims to keep guns from being sold to those … Continue Reading
Highmark Launches Accountable Care Alliance Attached is the press release; https://www.highmark.com/hmk2/newsroom/pressreleases/2013/pr071813.shtml More to come when the details are evaluaited.… Continue Reading